When the Gold Standard Comes Under Fire

A recent article questioned the research that was the basis for guidelines suggesting target bad cholesterol (LDL) of less than 70. It refers to the National Cholesterol Education Program (NCEP) guidelines on desirable cholesterol level that were revised in 2004. The guidelines are seen by some as a gold standard.
When they came out, these guidelines prompted some physicians to shoot for LDL cholesterol level of less than 70 for most of the patients. A perusal of the guidelines clarified that LDL cholesterol level of less than 70 is desirable only in certain special circumstances.

Ever since the cholesterol lowering medicines called statins have gone generic, we have seen direct to consumer marketing prompting people to take cholesterol-lowering medicines other than statins. One of the reasons given is that new medicines are different (just like wearing Versace is different?).

Here is my take:
- A case for aggressive lowering of cholesterol has partly been based on the data that effect of statins goes beyond just lowering cholesterol. Statins should be our first line of therapy for lowering cholesterol.
- More aggressive cholesterol goals prompt us to use higher doses of statins, and higher statin doses are more likely to cause side effects. These in turn affect patient compliance.
- There is a need for making the guidelines easier to follow, and less prone to spin by vested interests. We got some confusing signals from JNC 7 guidelines on high blood pressure as well.
- There is a growing group of people saying that standardized patient care saves money and life. The detractors think that the cookie-cutter version of medicine takes away flexibility from the treating doctors, and promotes mediocrity. The questioning of these guidelines has brought up another issue. They say that standardized care can sometimes be based on faulty guidelines. Based on that, they invoke a term from the computer world, GIGO. Advantage detractors?
Home Page